锥形扩张器用于椎间孔镜治疗腰椎间盘突出症效果

Effcacy of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar disc herniation using cone dilator.

摘要:

目的：评价锥形扩张器用于椎间孔镜治疗腰椎间盘突出症安全性及有效性。方法：腰椎间盘突出症患者50例，按照随机数字表法分为A、B两组，每组25例。A组行传统穿刺置管下椎间孔镜腰椎间盘突出髓核摘除术，B组行锥形扩张器下椎间孔镜腰椎间盘突出髓核摘除术。比较两组穿刺置管时间、手术时间，记录穿刺置管过程中触及神经（引起下肢麻木、胀痛)发生情况，记录手术相关并发症（硬膜囊撕裂、神经损伤、出血）发生情况。比较两组患者术前1d、术后3d、30d及1年VAS评分及JOA评分变化并评价治疗改善率。结果：B组穿刺置管时间、手术时间明显短于A组(P<0.O5)；穿刺置管过程中触及神经（引起下肢麻木、胀痛)发生情况B组2例（13%）明显少于A组10例（40%）(P<0.05)；B组无硬膜囊撕裂，A组2例硬膜囊撕裂，两组患者均无神经损伤及出血并发症发生。与治疗前比较，治疗后3 d、30 d、1年两组患者VAS评分明显降低（P<0.05），相同时点比较，两组患者VAS评分比较差异无统计学意义（P＞0.05）,治疗3 d 、30 d B组JOA 评分优效为20例(80 %)、23例(92 %)高于A组14例(56 %)、20例(80 %)（P<0.05）；治疗1年时B组JOA 评分优效24例（96 %）与A组23例（92 %）比较差异无统计学意义（P＞0.05）。结论:使用锥形扩张器降低了穿刺置管难度，避免反复椎间孔穿刺及置管导致神经根和硬膜囊损伤，减轻对患者正常腰椎生理平衡结构的破坏，有利于患者早期腰椎活动功能的恢复。锥形扩张器用于椎间孔镜治疗腰椎间盘突出症安全、有效，但需要注意选择合适的适应症。

Abstract:

Objective To investigate the safety and efficacy of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar disc herniation using cone dilator.Methods 50 patients with lumbar disc herniation were randomly divided into two groups,each twenty-five cases.The patients in group A were received traditional catheterization technique for percutaneous transforaminal endoscopic discectomy.Group B were received improved catheterization technique using cone dilatorfor for percutaneous transforaminal endoscopic discectomy.Puncture catheterize time, operation time and the incidence rate of Scratch nerve in the process of catheterization were recorded.Side effects such as Epidural capsule tearing, nerve damage and hemorrhage were also observed in both groups.The VAS ,JOA scale were recoreded at 1 d before the operation and 3 d,30 d,1 y after the operation respectively .Result Compared with group A,Puncture catheterize time, operation time were significantly lower in group B (P < 0.05);There were two cases（thirteen percent)in group B ,much less than ten cases（forty percent)in group A of the incidence rate of Scratch nerve in the process of catheterization(P<0.05).There were no Epidural capsule tearing occured in group B, but two cases occured in group A.There were no nerve damage and hemorrhage occured in both groups.VAS score were significantly lower in both group 3 d,30 d,1 y after the operation than preoperative(P < 0.05).At the same time, there were no difference for VAS score in two groups after treatment.JOA scale the optimal rate was twenty cases(eighty percent) at 3 d,and twenty-three(ninety-two percent) at 1 y after the operation in group B more exceed the same time fourteen cases(fifty-six percent )and twenty cases(eighty percent ) in group A（P<0.05）.But there are no distinction after one year. Conclusion:Two targets for percutaneous transforaminal endoscopic discectomy can safely and effectively cure lumbar disc herniation.